Gynaecology deals with contraception, the investigation and treatment of menstrual problems (see menstruation, disorders of), sexual problems, infertility, problems relating to the menopause, and disorders such as uterine fibroids and ovarian cysts.
Gynaecology also covers disorders of early pregnancy, such as recurrent miscarriage.
Clinical psychologists are involved in health care in the following ways: (1) Assessment of thoughts, emotions and behaviour using standardised methods. (2) Treatment based on theoretical models and scienti?c evidence about behaviour change. Behaviour change is considered when it contributes to physical, psychological or social functioning. (3) Consultation with other health-care professionals about problems concerning emotions, thinking and behaviour. (4) Research on a wide variety of topics including the relationship between stress, psychological functioning and disease; the aetiology of problem behaviours; methods and theories of behaviour change. (5) Teaching other professionals about normal and dysfunctional behaviour, emotions and functioning.
Clinical psychologists may specialise in work in particular branches of patient care, including surgery, psychiatry, geriatrics, paediatrics, mental handicap, obstetrics and gynaecology, cardiology, neurology, general practice and physical rehabilitation. Whilst the focus of their work is frequently the patient, at times it may encompass the behaviour of the health-care professionals.... clinical psychology
MIS is commonly carried out by means of an operating laparoscope (a type of ENDOSCOPE) that is slipped through a small incision in the skin. MIS now accounts for around 50 per cent
of all operations carried out in the UK. A small attachment on the end of the laparoscope provides an image that can be magni?ed on a screen, leaving the surgeon’s hands free to operate while his assistant operates the laparoscope. Halogen bulbs, ?breoptic cables and rod lenses have all contributed to the technical advancement of laparoscopes. Operations done in this manner include extracorporeal shock-wave LITHOTRIPSY for stones in the gall-bladder, biliary ducts and urinary system; removal of the gall-bladder; appendicectomy; removal of the spleen and adrenal glands; and thoracic sympathectomy. MIS is also used to remove cartilage or loose pieces of bone in the knee-joint.
This method of surgery usually means that patients can be treated on a day or overnight basis, allowing them to resume normal activities more quickly than with conventional surgery. It is safer and lessens the trauma and shock for patients needing surgery. MIS is also more cost e?ective, allowing hospitals to treat more patients in a year. Surgeons undertake special training in the use of MIS, a highly skilled technique, before they are permitted to use the procedures on patients. The use of MIS for hernia repair, colon surgery and repairs of duodenal perforations is under evaluation and its advantages will be enhanced by the development of robotic surgical techniques.... minimally invasive surgery (mis)
Each district has a general hospital providing services that include medicine, surgery, gynaecology, obstetrics, and paediatrics.
Some more specialist services are concentrated in fewer centres.
Many of the ’s private hospitals are nursing homes for the elderly; others cater for nonemergency surgery, obstetric care, or inpatient care for the mentally ill.... hospitals, types of
It takes up to 15 years to train a surgeon from the time at which he or she enters medical school; after graduating as a doctor a surgeon has to pass a comprehensive two-stage examination to become a fellow of one of the ?ve recognised colleges of surgeons in the UK and Ireland.
Surgery is carried out in specially designed operating theatres. Whereas it used to necessitate days and sometimes weeks of inpatient hospital care, many patients are now treated as day patients, often under local anaesthesia, being admitted in the morning and discharged later in the day.
More complex surgery, such as transplantation and neurosurgery, usually necessitates patients being nursed post-operatively in high-dependency units (see INTENSIVE THERAPY UNIT (ITU)) before being transferred to ordinary recovery wards. Successful surgery requires close co-operation between surgeons, physicians and radiologists as well as anaesthetists (see ANAESTHESIA), whose sophisticated techniques enable surgeons to undertake long and complex operations that were unthinkable 30 or more years ago. Surgical treatment of cancers is usually done in collaboration with oncologists. Successful surgery is also dependent on the skills of supporting sta? comprising nurses and operating-theatre technicians and the availability of up-to-date facilities.... surgery
Ayur (“life”) and veda (“science”), the science of life, is part of the Hindu writings – the Artharva- veda. By 500BC many of these writings, including a vast collection of ‘Materia medica’ gravitated to the University of Benares, to be joined 700 years later with another huge volume of medical literature which together formed the basis of the Ayurveda system. In rural India where Western medicine is absent it is still practised by 80 per cent of the population. Like the medical culture of China, that of India is among the oldest in the world. Today, its practitioners are skilled in gynaecology, obstetrics and other specialties.
It is a branch of Holistic medicine whereby body imbalances are restored by a natural regime, baths, fasting, enemas, cleansing diets and herbs. Time is given up to meditation and prayer for which many mantras exist. Those who practise it support the role of preventive medicine, insisting it is not only a system of cure but a metaphysical way of life touching body, mind and spirit. A strict daily discipline embraces yoga and special foods to maintain a sound and wholesome life. Ayurvedic medicine regards the herb Valerian as important for epilepsy.
Important Ayurvedic medicines include Borage, Liquorice, Cinnamon, Garlic, Gotu Kola and Wild Yam, renowned for their versatility. Of special importance to this system of medicine is the hypoglycaemic plant, Gymnema sylvestre, used since the 6th century for a condition known as “honey urine”, which today grows in popularity in the West for the treatment of diabetes. ... ayurveda medicine
Women who use barrier contraceptives are more than twice as likely to develop pre-eclampsia in pregnancy than those using non-barrier methods. (North Carolina Memorial Hospital)
Symptoms. Headache, dizziness, nausea, upper abdominal pain, twitching of face and limbs, albumin in the urine. Extreme cases: high blood pressure, rigidity, congestive heart failure.
Treatment. Hospitalisation. To be treated by qualified obstetrician.
Formula. Cramp bark 2; Motherwort 1; Black Cohosh 1. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: one to two 5ml teaspoons. Tinctures: 1-3 teaspoons. Hourly, or more frequently as tolerated; in water or honey. Magnesium sulphate for fits.
Suppression of urine. Dilation of kidney arterioles to increase flow of blood and to re-start kidney function.
Bearberry (Uva Ursi) tea. 1-2 teaspoon to each cup boiling water; infuse 15 minutes; 1 cup freely. Bearberry Liquid extract. 2-4ml hourly, or as tolerated, in water or honey.
White Willow. Conventional treatment places high-risk women on low-dose aspirin therapy. As White Willow is a source of natural aspirin, it would appear to offer some benefit. White Willow reduces platelet aggregation, and encourages placental blood flow. Aspirin of pharmacy cuts the risk of pregnancy-induced high blood pressure by two-thirds.
Diet. Pre-eclampsia: oily fish or fish oil supplements. (Journal of Obstetrics and Gynaecology 1990, 97 (12) 1077-79)
Supplements. Calcium. Magnesium.
Note: A serious condition which can be fatal but which can be prevented by regular antenatal examinations by a qualified obstetrician. ... eclampsia
Ultrasound is replacing ISOTOPE scanning in many situations, and also RADIOGRAPHY. Ultrasound of the liver can separate medical from surgical JAUNDICE in approximately 97 per cent of patients; it is very accurate in detecting and de?ning cystic lesions of the liver, but is less accurate with solid lesions – and yet will detect 85 per cent of secondary deposits (this is less than COMPUTED TOMOGRAPHY [CT] scanning). It is very accurate in detecting gall-stones (see GALL-BLADDER, DISEASES OF) and more accurate than the oral cholecystogram. It is useful as a screening test for pancreatic disease and can di?erentiate carcinoma of the pancreas from chronic pancreatitis with 85 per cent accuracy.
Ultrasound is the ?rst investigation indicated in patients presenting with renal failure, as it can quickly determine the size and shape of the kidney and whether there is any obstruction to the URETER. It is very sensitive to the presence of dilatation of the renal tract and will detect space-occupying lesions, di?erentiating cysts and tumours. It can detect also obstruction of the ureter due to renal stones by showing dilatations of the collecting system and the presence of the calculus. Adrenal (see ADRENAL GLANDS) tumours can be demonstrated by ultrasound, although it is less accurate than CT scanning.
The procedure is now the ?rst test for suspected aortic ANEURYSM and it can also show the presence of clot and delineate the true and false lumen. It is good at demonstrating subphrenic and subhepatic abscesses (see ABSCESS) and will show most intra-abdominal abscesses; CT scanning is however better for the retroperitoneal region. It has a major application in thyroid nodules as it can di?erentiate cystic from solid lesions and show the multiple lesions characteristic of the nodular GOITRE (see also THYROID GLAND, DISEASES OF). It cannot differentiate between a follicular adenoma and a carcinoma, as both these tumours are solid; nor can it demonstrate normal parathyroid glands. However, it can identify adenomas provided that they are more than 6 mm in diameter. Finally, ultrasound can di?erentiate masses in the SCROTUM into testicular and appendicular, and it can demonstrate impalpable testicular tumours. This is important as 15 per cent of testicular tumours metastasise whilst they are still impalpable.
Ultrasonic waves are one of the constituents in the shock treatment of certain types of gallstones and CALCULI in the urinary tract (see LITHOTRIPSY). They are also being used in the treatment of MENIÈRE’S DISEASE and of bruises and strains. In this ?eld of physiotherapy, ultrasonic therapy is proving of particular value in the treatment of acute injuries of soft tissue. If in such cases it is used immediately after the injury, or as soon as possible thereafter, prompt recovery is facilitated. For this reason it is being widely used in the treatment of sports injuries (see also SPORTS MEDICINE). The sound waves stimulate the healing process in damaged tissue.
Doppler ultrasound is a technique which shows the presence of vascular disease in the carotid and peripheral vessels, as it can detect the reduced blood ?ow through narrowed vessels.
Ultrasound in obstetrics Ultrasound has particular applications in obstetrics. A fetus can be seen with ultrasound from the seventh week of pregnancy, and the fetal heart can be demonstrated at this stage. Multiple pregnancy can also be diagnosed at this time by the demonstration of more than one gestation sac containing a viable fetus. A routine obstetric scan is usually performed between the 16th and 18th week of pregnancy when the fetus is easily demonstrated and most photogenic. The fetus can be measured to assess the gestational age, and the anatomy can also be checked. Intra-uterine growth retardation is much more reliably diagnosed by ultrasound than by clinical assessment. The site of the placenta can also be recorded and multiple pregnancies will be diagnosed at this stage. Fetal movements and even the heartbeat can be seen. A second scan is often done between the 32nd and 34th weeks to assess the position, size and growth rate of the baby. The resolution of equipment now available enables pre-natal diagnosis of a wide range of structural abnormalities to be diagnosed. SPINA BIFIDA, HYDROCEPHALUS and ANENCEPHALY are probably the most important, but other anomalies such as multicystic kidney, achondroplasia and certain congenital cardiac anomalies can also be identi?ed. Fetal gender can be determined from 20 weeks of gestation. Ultrasound is also useful as guidance for AMNIOCENTESIS.
In gynaecology, POLYCYSTIC OVARY SYNDROME can readily be detected as well as FIBROID and ovarian cysts. Ultrasound can monitor follicular growth when patients are being treated with infertility drugs. It is also useful in detecting ECTOPIC PREGNANCY. (See also PREGNANCY AND LABOUR.)... ultrasound
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